This document analyzes the effectiveness of cervical cancer screening in 90 municipalities in Rio de Janeiro, Brazil. Four groups of municipalities were identified based on cluster analysis of screening performance indicators. Group 1 had the highest rates of abnormal Pap smear results and consisted of more developed municipalities. Group 2 had the lowest rates and was less developed. The quality of Pap smear tests and preparation of cervical samples influenced detection of abnormalities more than simply increasing screening rates. Overall, the analysis revealed varying levels of screening effectiveness between municipalities related to socioeconomic factors.

1. Profile of the effectiveness of detection of
atypia by the cervical cancer screening in the
municipalities of Rio de Janeiro
Sulafa Y.M. Ahmed*, R.T. Almeida and
M.G.P. Silva

2. Introduction
• Among all malignant tumors, cervical cancer is
the one that can be most effectively
controlled by screening.
• Effective screening requires the monitoring of• Effective screening requires the monitoring of
performance indicators for each of its phases.
• By tradition, the analysis of these indicators is
fragmented.

3. Brazilian Screening Program
• Coverage of Pap smear test (87%) - public and private
healthcare systems (IBGE, 2008).
• Seventeen years of opportunistic Pap smears screening
controlled by the actions of National Program Against Cervical
Cancer.
• The program's actions are monitored and managed by mean
of the Cervical Cancer Information System (SISCOLO, in
Portuguese).
• SISCOLO provides information related to the cytopathology
and histopathology exams performed by the Brazilian Public
Healthcare System.

4. Objective
To establish the effectiveness profile
of the municipalities of the State of
Rio de Janeiro/ Brazil related to the
detection of atypia by means of adetection of atypia by means of a
multivariate analysis.

5. Materials and Methods - Data
Production of 65 535 Pap smear
tests during year 2007 was obtained
from SISCOLO for 90 municipalitiesfrom SISCOLO for 90 municipalities
of Rio de Janeiro State, Brazil.

6. Materials and Methods - Variables
• Atypia: positive exam for
cancer precursor lesions.
• Reference laboratory: exams
carried out by the reference
laboratory of the state.
• Immature metaplasia: lesions
without risk for progression to
carcinoma (caused by an
inflammatory process).
Seven variables were used, which express the proportion of
tests by the municipality for the following conditions:
carried out by the reference
laboratory of the state.
• Adequability of slices: slices
with material of the cervix
area most susceptible to have
cancer cells.
• Age: exams of the women
within the recommended age
of program (25-59).
inflammatory process).
• Microflora absence: exams
without detection of vaginal
micro-organisms.
• STD: Presence of micro-
organism related to sexually
transmitted diseases.

7. Materials and Methods - Statistical Analysis
To characterize the profile of the
municipalities, the cluster analysis
technique was used by mean of
hierarchical method (completehierarchical method (complete
aggregation) and Euclidean distance
applying the R Statistical Package.

8. Results – Identified Groups
The cluster analysis identified four groups
Group No. Municipalities Population %
G1 20 51
G2 8 1
Total Population: 15 989 929
G2 8 1
G3 25 41
G4 37 7

9. Results - Dispersion of groups for the variables
that best discriminate the groups

10. Results - Dispersion of groups for the variables
that best discriminate the groups

11. Results - Dispersion of groups for the variables
that best discriminate the groups

12. Results - Dispersion of groups for the variables
that best discriminate the groups

13. Results - Dispersion of groups for the variables
that best discriminate the groups

14. Results - Dispersion of groups for the variables
that best discriminate the groups

15. Results - Dispersion of groups for the variables
that best discriminate the groups

16. Results - Human Development Index for groups
Dispersion of groups Human Development Index

17. Results - Human Development Index for groups
Dispersion of groups Human Development Index

18. Discussion and Conclusion
• The profile of the detection of atypia revealed 3 different
levels of detections among the groups (G1, G 3-4, G2).
• The reference laboratory seems to influence more the
detection of atypia than the adequability of slices.
• Socioeconomic factors seems either to influence the• Socioeconomic factors seems either to influence the
detection of atypia (G2).
• This profile shows that in order to increase the detection
capacity, it seems more effective to improve the quality of the
standard of Pap Smear tests and the adequability of slices
than to increase the production of exams isolated.

19. Thanks!
Sulafa YM Ahmed
e-mail: sulafa@peb.ufrj.br
Acknowledgement:Acknowledgement:
TWAS-CNPq Postgraduate Fellowship Programme,
HTAi Low and Middle Income Country Travel Grant,
Coordination for the Improvement of Higher Education personnel